NSW Health Coronavirus (COVID-19) overview and scenarios for business continuity planning for AOD services - NADA
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NSW Health
Coronavirus (COVID-19) overview
and scenarios for business
continuity planning for AOD
services
1
Objectives ►Discuss some basic respiratory epidemic concepts ►Inform your thinking and enhance your ability to plan for your service ►Support critical service delivery and communication ►Remain flexible and open to new information, given ►Level of uncertainty; new virus and new disease ►Rapidly changing context.
Epidemics and pandemics
► An epidemic is an increase in the number of cases of a disease above what is expected in that population
and region – local or regional
► A pandemic is a global outbreak of disease caused by a new pathogen (for example, a new coronavirus),
usually affecting a large number of people
Note:
Pandemic definition refers to transmissibility, novelty and geographic extent
Does not refer to or describe intensity or severity of illness
Pandemics can vary substantially in their impacts and severity
► WHO usually declares a pandemic
Last pandemic was H1N1 influenza in 2009-10 – est 200,000 global deaths
Previous H1N1 influenza pandemic was in 1918-19 – est 20-40 million global deaths
3
4
Features of respiratory virus
epidemics vs pandemics
Respiratory epidemic Respiratory pandemic
► May be well-defined seasonal illness ► Often inter-seasonal illness
► Annual wave of illness ► May produce a second wave or ongoing
► Infected proportion 5-10% ► Infected proportion 10-30%, or more
► Some background immunity ► No/limited background immunity
► May be specific interventions available ► May be limited or no specific treatment
► High risk groups – very elderly, very available
young ► High risk groups – may be variable age
► Worse in institutions/hospitals ► Worse in institutions/hospitals
► Local/regional health impacts ► Global, concurrent, widespread impacts
- may include economic, social and health
impacts
- potential business disruption, including
supply chain
5
Spanish Influenza. N.S.W - 1919
Deaths per week, January to September
900
The
The Whole
Whole State
State
800 Metropolitan
Metropolitan Combined
Combined Sanitary
Sanitary Districts
Districts
700
Total Deaths
600
500
400
300
200
100
0
Week Ending 1 7 214 321 428 54 611 78 825 94 10111213141516171819202122232425262728293031
11 18 25 1 8 15 22 29 6 13 20 27 3 10 17 24 1 8 15 22 29 5 3233343536 373839
12 19 26 2 9 16 23 30
Jan Feb Mar Apr May Jun Jul Aug Sep
6The second wave(s) in the UK, 1918-1919
Weekly combined influenza and pneumonia mortality, UK, 1918–1919
7
Source: Taubenberger JK, Morens DM. (2006) 1918 Influenza: the Mother of All Pandemics. EID 12(1): Available at: http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htmPandemic response phases
8Pandemic mitigation strategy
1. Delay outbreak peak – buy time to prepare
2. Reduce peak burden on services / systems
3. Diminish overall cases and health impacts
9Pandemic patterns
► A pandemic may have substantial system impacts ~4-10 weeks after confirmation of sustained community
transmission
► Timing depends on incubation period/serial interval, how early community transmission is recognised, and
whether containment efforts can be sustained
► Normal patterns of flu spread are inner metro → outer metro → regional, with ~2-4 week delay from metro
to regional peaks, but may be patchy
► A respiratory pandemic wave could last longer than a typical influenza season (eg 10-15 weeks vs 6-10
weeks), could recur within a year (ie a second wave) or be ongoing at lower intensity for some time
► Impacts may be more severe if a pandemic wave coincides with the normal influenza season/winter.
10Coronavirus (COVID-19)
11What is this new disease?
► COVID-19 – the name for the disease (the entire spectrum of illness)
ie coronavirus disease 2019
► SARS-CoV-2 – the virus that causes the disease (previously 2019nCoV)
Recognises the new virus is closely related to the SARS virus identified in 2003 (same species, different
member), but the disease spectrum is different
► Similar logic: AIDS was the name of the disease caused by HIV
12COVID-19 current situation – status as of 6 March
https://gisanddata.maps.arcgis.com/apps/opsdashboard/
13Coronaviruses
► A large family of viruses. Some cause illness in people, and others circulate among animals, including bats.
► There are coronaviruses that cause mild illness in humans, such as the common cold.
► Two severe acute respiratory outbreaks related to MERS-CoV (2012 ongoing) and SARS-CoV (2003).
SARS-CoV-2 (causes COVID-19)
Clinical presentation Fever and/or respiratory symptoms including cough, sore throat (~80%)
Some people develop moderate to severe pneumonia (~17%), with or without acute
respiratory distress syndrome (~3%)
Mode of transmission Human-to-human transmission by respiratory droplets and by fomites (contaminated objects
and surfaces) are likely predominant transmission mode.
Incubation period Likely 2 to 14 days; median ~5 days.
Infectious period Evidence on the duration of infectivity for SARS-CoV-2 infection is evolving.
The contribution of pre-symptomatic transmission is likely low. However, as a precaution an
infectious period of 24 hours prior to the onset of symptoms is being used.
14Viral factors influencing pandemic impact
► How easily the virus is spread (transmissibility)
► What proportion of the population become unwell (clinical attack rate)
► How sick it makes people (morbidity)
► How deadly it is (mortality)
► What age groups will be most vulnerable (demographic distribution)
15Source: Australian Health Management Plan for Pandemic Influenza, August 2019
1617
Disasters vs infectious disease emergencies
Similarities and differences
Similarities
► Some acute/unpredictable system impacts
► Business continuity considerations – but disasters often short-lived, localised
Differences
► Infectious disease – infection control incl. PPE, fear, nosocomial transmission
► Staff absenteeism due to illness/caring – may reach around 20%
(service re-deployments and extended home isolation may exacerbate staff shortages)
► Statewide / multi service impacts
► Duration and intensity – potentially 2-3 months, ongoing surge/staffing 24/7
► However – some warning – specific preparedness / planning possible
18Mitigation strategies - general
► Infection control, eg hand washing, resp etiquette, use of PPE
► Home isolation (mildly unwell people stay home)
► Social distancing (not the same as quarantine)
► Remote working
► Cancel / defer mass gatherings
► ? Temporary closure of schools / child care centres
► Supportive / symptomatic care, including for severe cases
Later:
Specific medical treatments – antivirals, immunosuppresants/modulators
Vaccines
19Business continuity considerations
► Fear and anxiety
► Communication channels and messages, consumer information provision/updates
► Infection control and cleaning
► Patient/HCW safety and isolation, segregation (keep uninfected away from infected)
► Staff absenteeism and surge (potentially months)
► System redeployments and flow-on impacts
► Staff training and education, esp re PPE use and potential refreshers/on-the-job training
► Criticality of services and staff; service inter-dependencies; modes of service delivery (F:F/tele/digital)
► Vulnerable populations – HCWs, carers, pregnant women, ATSI, elderly, comorbidities (resp, diabetes, CVD)
► Community service closures/interruptions eg GPs, pharmacies – alternate models of community care
► Setting specific issues – institutional or residential, including prisons, IDAT
► Engineering or physical arrangements
► Linen and waste management
► Supply chains and logistics – meds, PPE, other medical equipment, delivery options
20Mitigations strategies – specific to AOD context
► Use of depot – speed up roll out, expand eligibility
► Ambulatory services – tele / digital support in place of F-F
► Modified supervised administration requirements – risk assmt
► Cancel/defer elective/discretionary services
► Re-deploy staff to essential/critical services eg OTP
► Minimise residential service and hospital admission
► Consider vulnerable clients, and at-risk groups – ? enhanced care/f-up
► Pregnant women, ATSI, resp co-morbidities, homeless
Localise, tailor
2122
Infection prevention and control principles
► Standard and transmission based precautions
► Isolation or segregation if appropriate (consider patient flows)
► Hand hygiene using hand washing and/or alcohol-based hand rub
► Respiratory etiquette principles apply
► PPE (requires training and support eg fit checking; may require buddy system)
► Environmental cleaning (cleaning and disinfection)
► Waste management follows normal infectious clinical waste processes
► Linen management follows normal processes.
Clinical Excellence Commission
23Workforce Issues
It is difficult to predict the workforce impact of a pandemic
Effects could range between from a slight increase in usual absenteeism to large
workforce absences with up to 35% of the adult population sick
24Estmated absenteeism during hypothetical influenza
pandemic
30
25
Absenteeism (% of
workforce)
20
Summer estimate
15
Winter estimate
10
5
0
1 2 3 4 5 6 7 8 9
Week of pandemic
MODEL ASSUMPTIONS
1. Pandemic over a period of 8 weeks 2. Overall attack rate 25%
3. Usual absenteeism rate (holidays plus sickness) 4. Each case off work for 7 days
= 10% in summer, 15% in winter
Does not include those who: (i) stay home to look after sick, or, (ii) stay away for other reasons
25Uncertainty and scenario planning
Suggested scenarios
► BAU + PPE/IC precautions / related service impacts
► Mild – absenteeism up to 10% + PPE/IC impacts
► Moderate – absenteeism/redeployments up to 20% + PPE/IC impacts
► Severe - critical service provision only + PPE/IC impacts
Consider
► Vulnerable clients / communities and health literacy, communications
► At-risk populations (also at-risk HCWs)
► Service settings – esp residential or institutional?
► Level of client reliance on services / service criticality
► Medication supply and delivery options, other logistics issues
► Digital /tele vs face-to-face ambulatory service delivery options
► Service rationing – prioritisation framework, ethics
► Extended surge duration and staff fatigue / burnout – adequate rostering; critical staff relief/back-ups
26Summary
► Need to plan now – potential long surge, substantial workforce impacts
► Factor in substantial uncertainty re timing, severity, impacts
► Plan specifically for critical service continuity
► Consider specific ramp up of depot bup, remote working, IC training
► Consideration vulnerable/at-risk groups
► Plan for most impacts coinciding with winter
27Useful links
► NSW Health website: https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus.aspx
► FAQs: https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx
► CEC: http://www.cec.health.nsw.gov.au/patient-safety-programs/infection-prevention-and-control/novel-coronavirus-2019-
ncov
► NSW Health Weibo account: https://weibo.com/u/7382317434
► Twitter: @NSWHealth
► Facebook: https://www.facebook.com/NewSouthWalesHealth/
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